up da t e - iowa

d a t eG R A N T E E

U PJune 29, 2009

The Update is a bi-weekly Web newsletter published by the Iowa Department of Public Health’s Bureau of Family Health. It is posted the second and fourth week of every month, and provides useful job resource information for departmental health care professionals, information on training opportunities, intradepartmental reports and meetings, and additional information pertinent to health care professionals.

EPSDT Web Pages Now Posted!The Bureau of Family Health’s EPSDT Team and the Communications Workgroup is pleased to announce the posting of the newly revised EPSDT Care for Kids Web pages!

The EPSDT Care for Kids Web pages include the following links:

Information for Parents (eligibility, services provided, why EPSDT exams are important, where to get additional information and resources)

Information for Providers (resources to assist providers in implementing the EPSDT Care for Kids program) Resources Educational Materials Contact Information

Please visit the new EPSDT Care for Kids Web pages atwww.idph.state.ia.us/hpcdp/epsdt_care_for_kids.asp and provide feedback to Heather Hobert Hoch at [email protected].

1 Cover

2 DHS Iowa Administrative Code Rules - Medicaid & hawk-i Eligibility

3-4 Iowa Medicaid Introduces Interpretation Services

4 Updated hawk-i Fact Sheets

5 AAPD Revises Oral Health Guidelines for Expectant Moms

6 Calendar of Events

7 Staff Directory

8-27 Additional Materials

EPSDT Care for Kids

What is the EPSDT Care for Kids program?EPSDT is the Early Periodic, Screening, Diagnosis and Treatment program for children who are enrolled in Medicaid. The focus of this program is to assure that eligible children birth through ages 20 years receive preventive health care services, including oral health care. In Iowa, the EPSDT program is called Care for Kids. EPSDT Care for Kids services are free to children enrolled in Medicaid.

The acronym EPSDT stands for:

Early Children should receive quality health care beginning at birth and continuing throughout childhood and adolescence including the identifi cation, diagnosis and treatment of medical conditions as early as possible.

Periodic Children should receive well child check-ups at regular intervals throughout childhood according to standards set by the American Academy of Pediatrics. Health care may be provided between regularly scheduled check-ups.

Screening Children should be screened for health and developmental problems. Services shall include health history, developmental assessment, physical exam, immunization, lab tests, health education, dental exam, and vision and hearing screenings.

Diagnosis Children should receive further evaluation of health or developmental problems identifi ed during check-ups that may require treatment.

Treatment Children should receive treatment for health or developmental problems identifi ed during check-ups.

For more information: 1-800-383-3826You may also use the “Contact Us” link to submit questions online.

PROVIDERS

PARENTS

RESOURCES

CONTACT INFO

EDUCATIONALMATERIALS

DHS Iowa Administrative Code Rules - Medicaid & hawk-i EligibilityThe Iowa Medicaid Enterprise (IME) has posted several sets of Iowa Administrative Code rules related to Medicaid and hawk-i eligibility that may be of interest to your agency. The following have been noticed on the IME Rules Docket at www.dhs.iowa.gov/policyanalysis/RulesPages/dockets.htm.

ARC 7929B: An amendment adopted and fi led emergency effective July 1, 2009 that removes two of the requirements for an infant to be deemed Medicaid eligible for 12 months based upon their ‘newborn’ status. Any infant in Iowa who was born to a woman who was Medicaid-eligible at the time of birth shall remain eligible through the month of the child’s fi rst birthday, even if the child is no longer living with the mother or the mother no longer qualifi es for Medicaid. View ARC 7929B on pages 8-9 of The Update.

ARC 7931B: An amendment adopted and fi led emergency effective July 1, 2009 that increases the Medicaid income limit for pregnant women and for infants less than one year of age to 300 percent of the federal poverty level. It also eliminates an income deduction equal to 15 percent of the poverty level for infants and pregnant women, which has been used to effectively increase the previous income limit from 185 percent to 200 percent of the federal poverty level. Under this amendment, pregnant women will move from the IowaCare program to regular Medicaid, unless they are ineligible for Medicaid due to excess resources. View ARC 7931B on pages 10-12 of The Update.

ARC 7932B: An amendment adopted and fi led emergency effective July 1, 2009 that provides that children in lawful permanent resident status may receive Medicaid coverage if they are otherwise eligible, regardless of their date of entry to the U.S. This amendment does not extend coverage to children who do not have documentation of their legal entry to the U.S. See ARC 7932B on pages 13-15 of The Update.

ARC 7881B: An amendment adopted and fi led emergency effective July 1, 2009 that provides that children in lawful permanent resident status may receive hawk-i coverage if they are otherwise eligible, regardless of their date of entry to the U.S. This amendment does not extend coverage to children who do not have documentation of their legal entry to the U.S. View ARC 7881B on pages 16-17 of The Update.

ARC 7770B: An amendment adopted and fi led effective July 1, 2009 that increases the hawk-i income limits from 200 percent of the federal poverty level to 300 percent of the federal poverty level and implements increased monthly cost sharing for children with countable family income at or more than 200 percent of the federal poverty level ($20 per month per child up to a maximum of $40 per family). View ARC 7770B on pages 18-22 of The Update.

P r o g r a m M a n a g e m e n t

P r o g r a m M a n a g e m e n tcontinued...

Iowa Medicaid Introduces Interpretation ServicesTwo informational letters have been released by the Iowa Medicaid Enterprise (IME) that pertain to interpretation services to be covered under various Medicaid programs effective July 1, 2009. Note that these services must be included in your agency’s approved Cost Analysis prior to billing.

Informational Letter #811 addresses interpretation services and requirements pertaining to Family Planning programs.

Informational Letter #812 addresses interpretation services and requirements pertaining to Title V Maternal and Child Health programs.

For all agencies, two new codes will be opened:

T1013 - Sign language or oral interpretive services; 15 minute unit; fee schedule maximum of $15 per unit

W5023 - Telephonic oral interpretive services; 1 minute unit; fee schedule maximum of $1.70 per unit

In order for these services to be covered by Iowa Medicaid, the services must meet the following criteria:

Services must be provided by designated interpreters that provide ONLY interpretive services (employed or contracted staff)

The interpretive services must facilitate access to Medicaid covered services. Providers may only bill for interpretive services provided in conjunction with another Medicaid service. Medical staff who are bilingual are not reimbursed for the interpretation, but only for the medical service they provide. Note that Family Planning providers must include the interpretive service code on the same claim form as the payable Medicaid service

Reimbursable time may include the interpreter’s travel and wait time

Documentation requirements include the following:

Interpreter’s name or company

Date and time of interpretation

Service duration (time in and time out)

Cost of providing the service

continued on next page

P r o g r a m M a n a g e m e n tcontinued...

Iowa Medicaid Introduces Interpretation ServicesIt is the responsibility of the billing provider to determine the interpreter’s competency. Sign language interpreters should be licensed according to the Iowa Administrative Code 645 Chapter 361. Oral interpreters should be guided by the standards developed by the National Council on Interpreting in Health Care (www.ncihc.org).

For more information, please view Informational Letter #811 on pages 23-24 of The Update and Informational Letter #812 on page 25 of The Update. If you have questions, please contact IME provider services at 1-800-338-7909 (515-725-1004 in the Des Moines area) or by e-mail at [email protected].

Updated hawk-i Fact SheetsThe hawk-i fact sheets, available in English and Spanish, have been updated to refl ect the increase in income limits to 300 percent of the federal poverty level, effective July 1, 2009. To download the updated fact sheets, go to pages 26-27 of The Update.

W O R T H N O T I N G

AAPD Revises Oral Health Guidelines for Expectant Moms

Modifi ed oral health guidelines from the American Academy of Pediatric Dentistry (AAPD) include a call for all pregnant women to receive counseling and oral health care during pregnancy. Additionally, infants should be given an oral health risk assessment and oral care before their 1-year birthday, according to the new guidance. The new guidelines are designed to ensure better oral health for the mother and baby.

The guidelines are substantiated by studies that indicate how perinatal dental care can prevent preterm and low-birth weight babies, and how it is equally signifi cant to overall health for pregnant women, especially for the upcoming delivery.

The revised guidance also stresses appropriate oral care for infants and toddlers, an age group vulnerable to early childhood caries (ECC). Simple lifestyle changes related to a mother’s oral hygiene, diet, use of topical fl uoride and not sharing eating utensils can signifi cantly lower a child’s chances of having ECC.

Physicians are encouraged to address the new AAPD guidelines with patients. The AAPD is also calling for the curriculum at medical, nursing and allied health professional programs to involve education in perinatal and infant oral health.

To read the updated guidelines, visit AAPD’s Web site at www.aapd.org.

C A L E N D A R O F E V E N T S

July 1, 2009Early Childhood Iowa Professional Development Component Group Meeting9:30 a.m. - 4 p.m.DMACC Conference Center, in Newton

July 9, 2009Early Childhood Iowa Regional Meeting8:30 a.m. - 12 p.m.Greteman Center (attached to Holy Spirit Parish), 421 East Bluff Street in CarrollIf you would like to attend this meeting, please RSVP to Jenny Hodges at [email protected] or call (515) 281-4926.

*October 5-6, 2009BFH-CSCH Fall SeminarGateway Conference Center, Ames

October 15, 2009Adolescent Health ConferenceCedar Rapids

*Required meeting

Bureau of Family Health: 1-800-383-3826 Teen Line: 1-800-443-8336 Healthy Families Line: 1-800-369-2229 FAX: 515-242-6013

NAME PHONE E-MAIL

Beaman, Janet 281-3052 [email protected] Borst, M. Jane (Bureau Chief) 281-4911 [email protected]

Brown, Kim 281-3126 [email protected] Clausen, Sally 281-6071 [email protected] Connet, Andrew 281-7184 [email protected] Cox, Jinifer 281-7085 [email protected] Dhooge, Lucia 281-7613 [email protected] Doyle Scar, Angie 242-5980 [email protected] Ellis, Melissa 281-7044 [email protected] Goebel, Patrick 281-3826 [email protected] Hageman, Gretchen 281-7585 [email protected] Hinton, Carol 281-6924 [email protected] Hobert Hoch, Heather 281-6880 [email protected] Hodges, Jenny 281-4926 [email protected] Hummel, Brad 281-5401 [email protected] Johnson, Marcus 242-6284 [email protected] Jones, Beth 281-7044 [email protected] Miller, Lindsay 281-7721 [email protected] Monsma, Alison 281-7368 [email protected] Montgomery, Juli 242-5593 [email protected] O’Hollearn, Tammy 242-5639 [email protected] Pearson, Analisa 281-7519 [email protected] Peterson, Janet 242-6388 [email protected] Piper, Kim 281-6466 [email protected] Schulte, Kelly 281-8284 [email protected] Trusty, Stephanie 281-4731 [email protected] Wheeler, Denise 281-4907 [email protected]

Area code is 515

1

ARC 7929B

HUMAN SERVICES DEPARTMENT [441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 234.6 and 2008 Iowa Acts, chapter 1187,

section 6(6), the Department of Human Services amends Chapter 75, “Conditions of Eligibility,”

Iowa Administrative Code.

This amendment removes two of the requirements for an infant to be deemed Medicaid-

eligible for 12 months because of “newborn” status, a mandatory coverage group under the

Medicaid program. Based on legislation enacted in the Children’s Health Insurance Program

Reauthorization Act (CHIPRA), Public Law 111-3, states shall no longer require that the infant

must live with the mother or that the mother must continue to meet the Medicaid eligibility

requirements that would apply if she were still pregnant.

The effect of this amendment is that any infant in Iowa who was born to a woman who

was Medicaid-eligible at the time of birth shall remain eligible through the month of the child’s

first birthday, even if no long living with the mother, or the mother would no longer qualify for

Medicaid. This change will ensure the continuous availability of medical care during the child’s

first year of life and is in line with state’s vision to provide health care to all Iowa children.

This amendment does not provide for waivers in specified situations, since the change is

a benefit to the infants affected. Requests for the waiver of any rule may be submitted under the

Department’s general rule on exceptions at 441--1.8(17A,217).

The Council on Human Services adopted this amendment on June 10, 2009.

2

The Department finds that notice and public participation are unnecessary, in that the rule

change is necessary to meet federal requirements, and impracticable, because there is insufficient

time to allow for public comment before the effective date required. Therefore, these

amendments are filed pursuant to Iowa Code section 17A.4(3).

The Department also finds, pursuant to Iowa Code section 17A.5(2)“b”(1), that the

normal effective date of this amendment should be waived, as authorized by 2008 Iowa Acts,

chapter 1187, section 6(6).

This amendment is also published herein under Notice of Intended Action as ARC

7930B to allow for public comment.

This amendment is intended to implement Iowa Code section 249A.4 and Public Law

111-3, section 113(b)(1).

These amendments becomes effective July 1, 2009.

The following amendment is adopted.

Amend subrule 75.1(20) as follows:

75.1(20) Newborn children of Medicaid-eligible mothers. Medicaid shall be available

without an application to newborn children of women who are determined eligible for Medicaid

for the month of the child’s birth or for three-day emergency services for labor and delivery for

the child’s birth. Eligibility begins with the month of the birth and continues through the month

of the first birthday as long as the child lives with the mother and the mother remains eligible for

Medicaid or would be eligible if she were still pregnant or qualified for emergency services for

childbirth an Iowa resident.

a. and b. No change.

http://www.dhs.iowa.gov/policyanalysis/RulesPages/RuleDocuments/RulesInProcess/arc%207930b.pdf


1

ARC 7931B



Pursuant to the authority of Iowa Code section 249A.4, the Department of Human

Services amends Chapter 75, “Conditions of Eligibility,” Iowa Administrative Code.

This amendment increases the Medicaid income limit for pregnant women and for infants

less than one year of age to 300 percent of the federal poverty level, as mandated by 2009 Iowa

Acts, Senate File 389. It also eliminates an income deduction equal to 15 percent of the poverty

level for infants and pregnant women, which had been used to effectively increase the previous

income limit from 185 percent to 200 percent of the federal poverty level. Under this

amendment, pregnant women will move from the IowaCare program to regular Medicaid unless

they are ineligible for Medicaid due to excess resources.

This amendment does not provide for waivers in specified situations. Requests for the

waiver of any rule may be submitted under the Department’s general rule on exceptions at

441--1.8(17A,217), but the Department has no authority to waive statutory language.

The Council on Human Services adopted this amendment on June 10, 2009.

The Department finds that notice and public participation are unnecessary, since these

changes are mandated by state legislation and the Department has no alternative to their

implementation. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(3).

The Department also finds that this amendment confers a benefit on the persons affected

by raising the income limits for Medicaid eligibility. Therefore, this amendment is filed pursuant

2

to Iowa Code section 17A.5(2)“b”(2), and the normal effective date of this amendment is

waived.

This amendment is intended to implement Iowa Code section 249A.3(1)(l) as amended

by 2009 Iowa Acts, Senate File 389, section 16.

This amendment becomes effective July 1, 2009.


Amend subparagraph 75.1(28)“a”(1) as follows:

(1) Family income shall not exceed 185 300 percent of the federal poverty level for

pregnant women when establishing initial eligibility under these provisions and for infants

(under one year of age) when establishing initial and ongoing eligibility. Family income shall

not exceed 133 percent of the federal poverty level for children who have attained one year of

age but who have not attained 19 years of age. Income to be considered in determining

eligibility for pregnant women, infants, and children shall be determined according to family

medical assistance program (FMAP) methodologies except that the three-step process for

determining initial eligibility and the two-step process for determining ongoing eligibility, as

described at rule 441—75.57(249A), shall not apply. “Family income” is the income remaining

after disregards and deductions have been applied in accordance with the provisions of as

provided in rule 441—75.57(249A).

In determining eligibility for pregnant women and infants, after the aforementioned

disregards and deductions have been applied, an additional disregard equal to 15 percent of the

applicable federal poverty level shall be applied to the family’s income.

1

ARC 7932B



Pursuant to the authority of Iowa Code section 249A.4, the Department of Human

Services amends Chapter 75, “Conditions of Participation,” Iowa Administrative Code.

This amendment reflects the action of the Iowa General Assembly directing the

Department to provide Medicaid coverage to all eligible children for whom federal funding is

available. The Children’s Health Insurance Program Reauthorization Act of 2009 allows states

the option to extend coverage to all children who are lawful permanent residents of the United

States.

Previously, children who entered the U.S. on or after August 22, 1996, were barred from

participating in any federal means-tested program for five years from their date of entry. This

amendment provides that children in lawful permanent resident status may receive Medicaid

coverage if they are otherwise eligible, regardless of their date of entry to the U.S. This

amendment does not extend coverage to children who do not have documentation of their legal

entry to the U. S. The rule is also to amended conform to current formatting standards and

clarify the conditions of eligibility.

This amendment does not provide for waivers in specified situations since it benefits the

children affected by expanding eligibility. Requests for the waiver of any rule may be submitted

under the Department’s general rule on exceptions at 441--1.8(17A,217).

The Council on Human Services adopted these amendments on June 10, 2009.

2

The Department finds that notice and public participation are impracticable in that the

legislative directive to add coverage is effective on July 1, 2009, and there is not sufficient time

to allow for public participation before that date. Therefore, this amendment is filed pursuant to

Iowa Code section 17A.4(3).

The Department finds that this amendment confers a benefit by extending health

coverage to children who were previously ineligible. Therefore, this amendment is filed

pursuant to Iowa Code section 17A.5(2)“b”(2), and the normal effective date of this amendment

is waived.



This amendment is intended to implement Public Law 111-3 and Iowa Code Chapter

249A as amended by 2009 Iowa Acts, Senate File 389, section 13.

This amendment becomes effective on July 1, 2009.


Amend paragraph 75.11(2)“a” as follows:

a. To be eligible for Medicaid a person must be one of the following:

(1) A citizen or national of the United States.

(2) A qualified alien as defined in subrule 75.11(1) residing in the United States prior to

before August 22, 1996.

(3) A qualified An alien child under the age of 19 who entered the United States on or

after August 22, 1996, and who is lawfully admitted for permanent residence under the

Immigration and Nationality Act:.

● (4) A refugee who is admitted to the United States under Section 207 of the



3

Immigration and Nationality Act;.

● (5) An alien who has been Granted granted asylum under Section 208 of the

Immigration and Nationality Act;.

● (6) An alien whose deportation is being withheld under Section 243(h) of the

Immigration and Nationality Act;. or

● (7) A qualified alien veteran with a discharge characterized as who has an honorable

discharge and that is not on account of due to alienage,. an

(8) A qualified alien who is on active duty in the Armed Forces of the United States

other than active duty for training,. or

(9) A qualified alien who is the veteran’s spouse or unmarried dependent child of a

qualified alien described in subparagraph (7) or (8), including a surviving spouse who has not

remarried.

(4) (10) A qualified alien who entered the United States on or after August 22, 1996, and

who has resided in the United States for a period of at least five years.

1

ARC 7881B



Pursuant to the authority of Iowa Code section 514I.5, the Department of Human

Services amends Chapter 86, “Healthy and Well Kids in Iowa (HAWK-I) Program,” Iowa

Administrative Code.

This amendment reflects the action of the Iowa General Assembly directing the

Department to provide coverage under the Healthy and Well Kids in Iowa (HAWK-I) Program

to all eligible children for whom federal funding is available. The Children’s Health Insurance

Program Reauthorization Act of 2009 allows states the option to extend coverage funded through

the federal Children’s Health Insurance Program (HAWK-I in Iowa) to all children who are

lawful permanent residents of the United States.

Previously, children who entered the U.S. on or after August 22, 1996, were barred from

participating in any federal means-tested program for five years from their date of entry. This

amendment provides that children in lawful permanent resident status may receive HAWK-I

coverage if they are otherwise eligible, regardless of their date of entry to the U.S. This

amendment does not extend coverage to children who do not have documentation of their legal

entry to the U. S.

This amendment does not provide for waivers in specified situations since it benefits the

children affected by expanding eligibility. Requests for the waiver of any rule may be submitted

under the Department’s general rule on exceptions at 441--1.8(17A,217).

The HAWK-I Board adopted this amendment on May 19, 2009.

2

The Department finds that notice and public participation are impracticable in that the

legislative directive to add coverage is effective on July 1, 2009, and there is not sufficient time

to allow for public participation before that date. Therefore, this amendment is filed pursuant to

Iowa Code section 17A.4(3).

The Department finds that this amendment confers a benefit by extending health

coverage to children who were previously ineligible. Therefore, this amendment is filed

pursuant to Iowa Code section 17A.5(2)“b”(2), and the normal effective date of this amendment

is waived.



This amendment is intended to implement Public Law 111-3 and Iowa Code Chapter

514I as amended by 2009 Iowa Acts, Senate File 389, section 14.

This amendment becomes effective on July 1, 2009.


Amend subrule 86.2(7) as follows:

86.2(7) Citizenship and alien status. The child shall be a citizen or lawfully admitted

alien. The criteria established under 8 U.S.C. Section 1612(a)(2)(A) and the Balanced Budget

Act of 1997, subsection 5302, 441--subrule 75.11(2) shall be followed when determining

whether a lawfully admitted alien child is eligible to participate in the HAWK-I program. The

citizenship or alien status of the parents or other responsible person shall not be considered when

determining the eligibility of the child to participate in the program.



ARC 7770B


Adopted and Filed

Pursuant to the authority of Iowa Code section 514I.5(8) and 2008 Iowa Acts, chapter

1188, section 14, the Department of Human Services amends Chapter 86, “Healthy and Well

Kids in Iowa (HAWK-I) Program,” Iowa Administrative Code.

The amendments will:

• Increase the HAWK-I income limits from 200 percent of the federal poverty level to

300 percent of the federal poverty level ($5,513 per month for a family of four) beginning July 1,

2009.

• Implement increased monthly cost sharing for children with countable family income

at or more than 200 percent of the federal poverty level ($20 per month per child up to a

maximum of $40 per family).

The eligibility change was enacted in 2008 Iowa Acts, chapter 1188, as the “HAWK-I

Expansion Program.” This legislation also gives the HAWK-I Board the authority to set cost-

sharing amounts for children with family income between 200 and 300 percent of the federal

poverty level.

These amendments do not provide for waivers in specified situations because expanded

coverage is a benefit to the families affected. Requests for the waiver of any rule may be

submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).

Notice of Intended Action on these amendments was published in the Iowa

1

Administrative Bulletin on March 11, 2009, as ARC 7635B. The Department received no

comments on the Notice of Intended Action.

The Department has made the following changes to the rules as published in the Notice

of Intended Action:

• Added new item 4 to make technical changes to reflect the current name of the Food

Assistance Program and the program’s change from issuing benefits by paper coupons to

electronic benefits transfer.

• Revised subrules 86.8(1) and 86.8(2) to clarify that the countable income the

Department considers when determining the premium amount is the family’s gross countable

income minus 20 percent of any earned income. (See items 5 and 6.)

The HAWK-I Board adopted these amendments on April 20, 2009.

These amendments are intended to implement Iowa Code chapter 514I.

These amendments shall become effective on July 1, 2009.

The following amendments are adopted.

ITEM 1. Adopt the following new definitions in rule 441—86.1(514I):

“Earned income” means the earned income of all parents, spouses, and children under

the age of 19 who are not students who are living together in accordance with subrule 86.2(3).

Income shall be countable earned income when a person produces it as a result of the

performance of services. “Earned income” includes:

1. All income in the form of a salary, wages, tips, bonuses, and commissions earned as

an employee, and

2. The net profit from self-employment determined by comparing gross income

produced from self-employment with the allowable costs of producing the income. The

2


allowable costs of producing self-employment income shall be determined by the costs allowed

for income tax purposes. Additionally, the cost of depreciation of capital assets identified for

income tax purposes shall be allowed as a cost of doing business for self-employed persons.

Losses from a self-employment enterprise may not be used to offset income from any other

source.

“Gross countable income” means gross income minus exemptions permitted by

paragraph 86.2(2)“b.”

“Gross income” means a combination of the following:

1. Earned income,

2. Unearned income, and

3. Recurring lump-sum income prorated over the time the income is intended to cover.

“Recurring lump-sum income” means earned and unearned lump-sum income that is

received on a regular basis. These payments may include, but are not limited to:

1. Annual bonuses.

2. Lottery winnings that are paid out annually.

“Self-employed” means that a person satisfies any of the following conditions:

1. The person is not required to report to the office regularly except for specific purposes

such as sales training meetings, administrative meetings, or evaluation sessions; or

2. The person establishes the person’s own working hours, territory, and methods of

work; or

3. The person files quarterly reports of earnings, withholding payments, and FICA

payments to the Internal Revenue Service.

“Unearned income” means cash income of all parents, spouses, and children under the

3

age of 19 who are living together in accordance with subrule 86.2(3) that is not gained by labor

or service. The available unearned income shall be the amount remaining after the withholding

of taxes (Federal Insurance Contribution Act, state and federal income taxes). Examples of

unearned income include, but are not limited to:

1. Social security benefits, meaning the amount of the entitlement before withholding of

a Medicare premium.

2. Child support and alimony payments received for a member of the family.

3. Unemployment compensation.

4. Veterans benefits.

ITEM 2. Amend subrule 86.2(2), introductory paragraph, as follows:

86.2(2) Income. Countable income shall not exceed 200 percent of the federal poverty

level for a family of the same size when determining initial and ongoing eligibility for the

program.

ITEM 3. Rescind paragraph 86.2(2)“a” and adopt the following new paragraph in lieu

thereof:

a. Gross countable income. In determining initial and ongoing eligibility for the

HAWK-I program, gross countable income shall not exceed 300 percent of the federal poverty

level for a family of the same size.

ITEM 4. Amend subparagraph 86.2(2)“b”(3) as follows:

(3) The value of the coupon allotment benefits issued in the Food Stamp Assistance

Program.

ITEM 5. Rescind subrule 86.8(1) and adopt the following new subrule in lieu thereof:

4

86.8(1) Income considered. The countable income considered in determining the

premium amount shall be the family’s gross countable income minus 20 percent of the family’s

earned income.

ITEM 5. Amend subrule 86.8(2) as follows:

86.8(2) Premium amount. The premium amount shall be $10 per month per child up to a

maximum of $20 per month per family. Premiums under the HAWK-I program shall be

assessed as follows:

a. No premium is charged if:

(1) The eligible child is an American Indian or Alaskan Native; or

(2) The family’s countable income is less than 150 percent of the federal poverty level

for a family of the same size.

b. If the family’s countable income is equal to or exceeds 150 percent of the federal

poverty level for a family of the same size but does not exceed 200 percent of the federal poverty

level for a family of that size, the premium is $10 per child per month with a $20 monthly

maximum per family.

c. If the family’s countable income is equal to or exceeds 200 percent of the federal

poverty level for a family of the same size, the premium is $20 per child per month with a $40

monthly maximum per family.

5

IOWA MEDICAID ENTERPRISE – 100 ARMY POST ROAD - DES MOINES, IA 50315

CHESTER J. CULVER, GOVERNOR DEPARTMENT OF HUMAN SERVICES PATTY JUDGE, LT. GOVERNOR CHARLES J. KROGMEIER, DIRECTOR

INFORMATIONAL LETTER NO. 811 June 24, 2009 TO: Iowa Medicaid Advanced Registered Nurse Practitioners, Ambulance, Audiologists,

Behavioral Health, Birthing Centers, Chiropractors, Clinics, Dentists, Durable Medical Equipment and Supply Dealers, Family Planning, Independent Lab, Lead Investigation Agency, Occupational Therapists, Opticians, Optometrists, Orthopedic Shoe Dealers, Pharmacists, Physical Therapists, Physicians, Podiatrists, Psychologists, and Rehabilitation Agency Providers

FROM: Iowa Department of Human Services, Iowa Medicaid Enterprise RE: Translation and Interpretation Services Effective July 1, 2009 Iowa Medicaid will open two procedure codes for Translation and Interpretation Services. These codes are to be used by providers reimbursed by a fee schedule. The codes include:

• T1013 sign language or oral interpretive services o 15 minute unit o Fee schedule maximum of $15.00 per unit

• W5023 Telephonic oral interpretive services o One minute unit o Fee schedule maximum of $1.70 per unit

In order for translation/interpretation services to be covered by Iowa Medicaid, the services must meet the following criteria:

• Provided by interpreters who provide only interpretive services.

• Interpreters may be employed or contracted by the billing provider.

• The interpretive services must facilitate access to Medicaid covered services. Providers may only bill for these services if offered in conjunction with an otherwise Medicaid covered service. Medical staff that are bilingual are not reimbursed for the interpretation but only for their medical services.

• Reimbursable time may include the interpreter’s travel and wait time.

Documentation of the service

The billing provider must document in the patient’s record the interpreter’s name, company, date and time of the interpretation, service duration (time in & time out), and the cost of providing the service.

Qualifications It is the responsibility of the billing provider to determine the interpreter’s competency. Sign language interpreters should be licensed pursuant to Iowa Administrative Code 645 Chapter 361. Oral interpreters should be guided by the standards developed by the National Council on Interpreting in Health Care (www.ncihc.org)

Billing of Interpretive Services

• If Medicaid is primary or secondary to TPL, then the interpretive services code must be on the same claim form as a payable Medicaid service. If there is not a payable covered service, then the entire claim will deny, including the interpretive codes. The provider should then correct the claim, if applicable, and resubmit codes for all services provided.

• If Medicare is prime and has paid a service but denied the interpretive service, then the provider will follow the established protocol for billing a non-Medicare covered service. The 1500 claim form will be submitted for the interpretive code only and will be accompanied by the EOMB that shows the paid Medicare service and denied interpretive service code.

Providers reimbursed via cost reports. Providers such as hospitals, Federal Qualified Health Centers, Rural Health Clinics, Community Mental Health Centers, Remedial, Local Education Agencies, or Targeted Case Management whose reimbursement currently includes translation and interpretation services in the rates for their services will not use these new codes. Medicaid will continue to provide reimbursement by inclusion of these costs in the cost report methodology and not by billing the procedure codes listed above. Only providers reimbursed by fee schedule will bill these codes. If you have any questions, please contact IME Provider Services, 1-800-338-7909, locally 515-725-1004 or by e-mail at [email protected]

IOWA MEDICAID ENTERPRISE – 100 ARMY POST ROAD - DES MOINES, IA 50315

CHESTER J. CULVER, GOVERNOR DEPARTMENT OF HUMAN SERVICES PATTY JUDGE, LT. GOVERNOR CHARLES J. KROGMEIER, DIRECTOR

INFORMATIONAL LETTER NO. 812 June 24, 2009 TO: Iowa Medicaid Maternal Health Center and Screening Center Providers FROM: Iowa Department of Human Services, Iowa Medicaid Enterprise RE: Title V Translation and Interpretation Services Effective July 1, 2009 Iowa Medicaid will be opening two procedure codes for Translation and Interpretation Services. These codes are to be used by providers reimbursed by a fee schedule. The codes include:

• T1013 sign language or oral interpretive services o 15 minute unit o Fee schedule maximum of $15.00 per unit

• W5023 Telephonic oral interpretive services o One minute unit o Fee schedule maximum of $1.70 per unit

In order for translation/interpretation services to be covered by Iowa Medicaid, the services must meet the following criteria:

• Provided by interpreters who provide only interpretive services.

• Interpreters may be employed or contracted by the billing provider.

• The interpretive services must facilitate access to Medicaid covered services. Providers may only bill for these services if offered in conjunction with an otherwise Medicaid covered service. Medical staff that are bilingual are not reimbursed for the interpretation but only for their medical services.

• Reimbursable time may include the interpreter’s travel and wait time.

Documentation of the service

The billing provider must document in the patient’s record the interpreter’s name or company, date and time of the interpretation, service duration (time in & time out), and the cost of providing the service.

Qualifications It is the responsibility of the billing provider to determine the interpreter’s competency. Sign language interpreters should be licensed pursuant to Iowa Administrative Code 645 Chapter 361. Oral interpreters should be guided by the standards developed by the National Council on Interpreting in Health Care (www.ncihc.org) If you have any questions, please contact IME Provider Services, 1-800-338-7909, locally 515-725-1004 or by e-mail at [email protected]

hawk-i Fact Sheethawk-i is a program for uninsured children that provides no-cost or

low-cost health care coverage to children in working families.

EligibilityChildren and teens under 19 years of age who: Meet income guidelines (see charts) Are Iowa residents Are U.S. citizens or permanent legal residents Are not the dependent of a State of Iowa employee Are not eligible for Medicaid benefi ts

Covered ServicesDoctor visits Hospital care Prescriptions Well-child vists

Vaccines/shots Emergencies Surgery Dental care Vision examsHearing services Mental health/Substance abuse Speech therapy

Health Plan ProvidersChildren enrolled in hawk-i will get an insurance card and services through one of the health plans that participate in the program.

What does it cost?Look up your family’s income in the charts to see if your children may qualify for free or low-cost health care coverage. If your income is below the amounts listed in these charts, your children may qualify for Medicaid.

Family Size Medicaid(parents, spouses, stepparents & children under 19 living together)

If your family’s yearly countable income is in this chart, your children may be able to get FREE coverage under Medicaid

1 Up to $14,404

8765432

Up to $49,224Up to $44,250Up to $39,275Up to $34,301Up to $29,327Up to $24,353Up to $19,379

Family Size hawk-i(parents, spouses, stepparents & children under 19 living together)

If your family’s yearly countable income is in this chart, your children may be able to get FREE coverage under hawk-i

1 $14,405 to $16,244

8765432

$49,225 to $55,514$44,251 to $49,904$39,276 to $44,294$34,302 to $38,684$29,328 to $33,074$24,354 to $27,464$19,380 to $21,854

Family Size hawk-i(parents, spouses, stepparents & children under 19 living together)

If your family’s yearly countable income is in this chart, your children may be able to get hawk-i for $10-20 per month per child. No family pays more than $40 per month.

1 $16,245 to $32,490

8765432

$55,515 to $111,030$49,905 to $99,810$44,295 to $88,590$38,685 to $77,370$33,075 to $66,150$27,465 to $54,930$21,855 to $43,710

Updated June 2009

hawk-i Hoja de Informaciónhawk-i es un programa para niños no asegurados que provee seguro médico

gratuito o a bajo costo para los niños de familias de bajos recursos.

ElegibilidadSon elegibles los niños y adolescentes menores de 19 años quienes: Están dentro de los límites de ingresos (vea las tablas abajo) Son residentes de Iowa Son ciudadanos de los Estados Unidos o residentes permanentes legales No son los dependientes de un empleado del Estado de Iowa No son elegibles para los benefi cios de Medicaid

Servicios CubiertosVisitas Médicas Atención en Hospital Recetas Visitas del Programa de Niños SanosVacunas e Inyecciones Emergencias Cirugías Cuidado Dental Exámenes de la VistaServicios de Audición Salud Mental Y Atención de Abuso de Substancia Terapia del Habla

Proveedores del Plan de SaludLos niños matriculados en hawk-i recibirán una tarjeta de seguro médico y servicios a través de uno de los programas de salud que participan en el programa.

¿Cuánto Cuesta?Si el ingreso contable anual de su familia está abajo de las sumas escritas en las tablas, a sus hijos les puede ser posible obtener cobertura GRATIS bajo Medicaid.

Medicaid

1 Up to $14,404

8765432

Up to $49,224Up to $44,250Up to $39,275Up to $34,301Up to $29,327Up to $24,353Up to $19,379

Tamaño de la Familia hawk-i(padres, cónyuges, padrastros, y niños menores de 19 viviendo juntos)

Si el ingreso contable anual de su familia está en esta tabla, a sus hijos les puede ser posible obtener cobertura GRATIS bajo hawk-i

1 $14,405 to $16,244

8765432

$49,225 to $55,514$44,251 to $49,904$39,276 to $44,294$34,302 to $38,684$29,328 to $33,074$24,354 to $27,464$19,380 to $21,854

hawk-iSi el ingreso contable anual de su familia está en esta tabla, a sus hijos les puede ser posible obtener hawk-i por $10 por niño mensual. Ninguna familia pagará más de $20 mensual.

1 $16,245 to $32,490

8765432

$55,515 to $111,030$49,905 to $99,810$44,295 to $88,590$38,685 to $77,370$33,075 to $66,150$27,465 to $54,930$21,855 to $43,710

Updated June 2009

Tamaño de la Familia(padres, cónyuges, padrastros, y niños menores de 19 viviendo juntos)

Tamaño de la Familia(padres, cónyuges, padrastros, y niños menores de 19 viviendo juntos)

Si el ingreso contable anual de su familia está en esta tabla, a sus hijos les puede ser posible obtener cobertura GRATIS bajo Medicaid